Noninvasive Prediction of Pulmonary Capillary Wedge Pressure in Patients With Normal Left Ventricular Ejection Fraction: Comparison of Cardiac Magnetic Resonance With Comprehensive Echocardiography

• Published in: Journal of the American Society of Echocardiography Vol. 37; no. 5; pp. 486 - 494
• Main Authors: Rahi, Wissam, Hussain, Imad, Quinones, Miguel A., Zoghbi, William A., Shah, Dipan J., Nagueh, Sherif F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2024
• Subjects: Cardiac magnetic resonance; Diastolic function; Doppler; Echocardiography; Filling pressures; EF; Echocardiography; RV; CAD; CMR; PCWP; LV; HFpEF; LGE; RHC; HFrEF; IVRT; Filling pressures; AUC; GLS; Diastolic function; Ar; PA; CW; LA; Cardiac magnetic resonance; Doppler; TR
• ISSN: 0894-7317; 1097-6795
• DOI: 10.1016/j.echo.2024.02.001

Cardiac magnetic resonance (CMR) was recently reported to predict mean pulmonary capillary wedge pressure (PCWP). However, there is a paucity of data on its accuracy for estimation of PCWP in patients with normal left ventricular (LV) ejection fraction (EF). We sought to examine its accuracy against the invasive gold standard and to compare it with the accuracy of comprehensive echocardiography. Stable patients with EF of ≥50% who underwent right heart catheterization, CMR, and echocardiographic imaging within 1 week were included. Pulmonary capillary wedge pressure was estimated by CMR using a previously validated equation where PCWP is estimated based on the left atrial maximum volume and LV mass. Echocardiographic estimation of PCWP was based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines, taking into account the presence of myocardial disease. The mean age of the 79 patients was 55 ± 15 years, and 58.2% were female. There were 33 patients with PCWP >15 mm Hg by right heart catheterization. Cardiac magnetic resonance prediction of PCWP had an area under the curve (AUC) = 0.72. In comparison, echocardiographic prediction of PCWP showed a higher accuracy (AUC = 0.87 vs AUC = 0.72; P = .008). In patients with normal LV EF, CMR estimation of mean PCWP based on LV mass and left atrial volume has modest accuracy for detecting patients with mean PCWP >15 mm Hg. Comprehensive echocardiography predicts elevated PCWP with higher accuracy in comparison with CMR. The figure shows the key findings, and an example from a patient with HFpEF. Cardiac magnetic resonance images from a patient with HFpEF and mean wedge pressure at 25 mm Hg. The LV mass was normal, but the LA volume was increased. Echocardiographic images show mitral inflow, TD annular velocities, pulmonary vein velocities, and TR velocity from the same patient. Collectively, the echocardiographic findings are consistent with elevated mean wedge pressure. •In normal LV EF, CMR estimation of PCWP has modest accuracy.•Comprehensive echocardiography predicts PCWP with higher accuracy.•Echocardiography improves on CMR PCWP prediction.